Halenur Bozdağ

Prof. Dr. Enrico Sertoli (İtalyan fizyolog, histolog, anatomist, biyolog, kimyager) 1865 yılında sonradan Sertoli hücresi adı verilecek olan “cellule ramificate” dallanmış hücreleri ilk keşfeden bilim insanıdır. Başlangıçta işlevini tam olarak anlayamadığı bu hücrelerin sonraki çalışmaları ışığında germ hücre farklılaşmasından ve hasarlı germ hücrelerin fagositozundan sorumlu olduğu sonucuna vardı. İnfertil çiftlerde saptanan patolojilerin yaklaşık yarıya yakınından erkek faktörü sorumlu olmasına rağmen erkek infertilitesine yönelik çok fazla basılı Türkçe eser olmadığı dikkatimizi çekti. Bu amaçla konuyla ilgili tüm branşların katılımıyla Türkçe bir kitap hazırlama kararı verdik.

Aim: The purpose of this study is to investigate the association between maternal serum levels of alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG), unconjugatedestriol (uE3) and poor pregnancy outcomes, determine whether these markers are effective predictors of poor pregnancy outcomes and to compare their levels in women with prior cesarean section and no prior uterine surgery. Material and Methods: Women with cesarean section due to a previous uterine surgery (n= 87) and women with no prior uterine surgery and performed vaginal delivery (n= 105) whose prenatal care was performed in the same clinic were included. Second trimester maternal serum levels of AFP, HCG and uE3, as well as multiples of the median (MoM) of these markers were evaluated. Differences in biochemical marker levels between groups and their relationship to poor maternal-fetal outcomes were assessed. Results: AFP, HCG, and uE3 levels of second trimester screening test markers, no statistically significant difference was found between the groups. When both groups are evaluated together, there is a negative, statistically significant association between neonatal weight and AFP level. When comparing the presence of fetal complications and the biochemical markers of the second trimester screening test HCG and E3, no statistically significant difference was observed. It was found that AFP levels of cases with fetal complications were statistically significantly higher than those of cases without fetal complications (p<0.01). Conclusion: While high AFP-MoM levels may be a warning of fetal complications, second trimester screening test markers were found to be insufficient to predict maternal complications. The levels of these markers was not different between women with prior cesarean section or no prior uterine surgery. Conducting this study with a larger sample could provide further valuable information.

OBJECTIVE: Our aim is to elucidate the relationship between mediolateral episiotomy (MLE) angle and postpartum perineal pain. METHODS: This study was designed prospectively. Primiparous women with MLE in the postpartum period were included in the study and divided into three groups according to episiotomy angle ranges (Group 1: 60 degrees). Postpartum perineal pain was quantified with the short-form McGill Pain questionnaire (SF-MPQ) consisting of the following three parts: Sensory-affective-verbal descriptions, visual pain scale (VPS), and present pain intensity scale (PPI). Postpartum perineal pain scores on days 1 and 7 were compared among the angle group. RESULTS: Overall, 86 eligible women were enrolled in this study. Seventy-three women (85%) scored the perineal pain between 0 and 3 on the VPS and 13 women (15%) rated the pain from 4 to 6 on the 1st postpartum day. No significant differences were noted among the three groups regarding the total pain scores on SF-MPQ and on the each part of form at the 1st postpartum day. At 7 days postpartum, total pain score was found significantly high in Group 1 [Med; IQR (min-max)=0; 4 (0-5)] compared with Group 2 [Med; IQR (min-max)=0; 0(0-5)]. The pain scores obtained from the sensory, affective, VPS, and PPI parts of the questionnaire were [Med; IQR (min-max)=0; 1 (0-2)], [Med; IQR (min-max)=0; 1 (0-1)], [Med; IQR (min-max)=0; 2 (0-2)], and [Med; IQR (min-max)=0; 0.25 (0-1)], respectively, in Group 1. For Group 2, pain scores obtained from the sensory, affective, and PPI were [Med; IQR (min-max)=0; 0(0-1)]; and VPS was [Med; IQR (min-max)=0; 0(0-2)]. No significant differences were observed between Groups 1 and 2 for each part of the questionnaire on day 7. Percentage of need for analgesics on day 7 was found significantly higher in Group 1 (42.9%) than Group 2 (31.2%) CONCLUSION: MLE at an angle <40 degrees to the midline is associated with a higher score of perineal pain and an increase need for analgesics during the early postpartum days.

Purpose: Vitamin D plays an important role in the modulation of the immune system and anti-autoimmune activities. Autoimmune thyroid diseases related to endocrine disorders are associated with poor obstetric outcomes in pregnancy. Herein, we aimed to investigate the contribution of vitamin D hypovitaminosis to poor pregnancy outcomes in pregnant women with the positive autoimmune antibody. Materials and methods: This was a prospective case–control study that enrolled pregnant women at their first trimester. The pregnant women were divided based on thyroid antibody (TA) status (TA-positive pregnant group (TAs (+)) and negative group (TAs (−)). Vitamin D status was categorized as sufficient, insufficient, and deficient (severe and moderate). Results: A total of 283 pregnant women were enrolled in this study. A total of 219 pregnant women were assigned to the TAs (−) group and 64 to the TAs (+) group. The rate of vitamin D insufficiency was 8.7, and 7.8% in the pregnant with TAs (−), and the pregnant with TAs (+) groups, respectively. Vitamin D deficiency was highly prevalent in all groups. Specifically, the prevalence rate was 91 and 92% in the pregnant with TAs (−) and the pregnant with TAs (+) groups, respectively. Admission to the neonatal intensive care unit (NICU) was more prevalent in the pregnant with TAs (+) group than in the pregnant with TAs (−) group (40.6 versus 25%; p = .0187; effect size (ES) = 0.134). The rate of gestational diabetes mellitus (GDM) was significantly higher in the pregnant women with TAs (+) group than that in the pregnant women with TAs (−) group (12.5 versus 4.1%; p = .03; ES =0.13). The rate of NICU admission and GDM was significantly higher in the severe vitamin D-deficient pregnant group with TAs (+) than that in the severe vitamin D-deficient pregnant group with TAs (−) (47 versus 23%; p = .007; ES =0.207 and 19.4% versus 4.1%; p = .006; ES =0.214, respectively). Conclusions: Severe vitamin D deficiency may contribute to increase the prevalence of GDM and need for NICU admission in pregnant women with positive TA.

Background/aim: We aimed to investigate whether oocyte morphologic abnormalities affected cycle outcome in poor responder infertile women who fulfilled the Bologna criteria. Materials and methods: Data were obtained from infertile couples who underwent ICSI and embryo transfer at the Zeynep Kamil Maternity and Children's Health Training and Research Hospital Assisted Reproduction Unit in Istanbul, Turkey. They were allocated to two groups: Group A, poor responders, and Group B, normal responders. All morphological abnormalities of oocytes retrieved were reviewed and grouped as cytoplasmic abnormalities or extracytoplasmic abnormalities. All morphological features were compared between the poor and normal responder groups. ICSI cycle outcomes were described as biochemical pregnancy, fertilization rate, number of top-quality zygotes, top-quality zygote rate, number of embryos transferred, and number of top-quality embryos transferred. The relation between each morphological feature and ICSI outcomes was investigated in each group. Results: The results showed no difference between the groups in terms of morphological features of oocytes. The relation between ICSI cycle outcomes and each oocyte morphological feature was compared in the poor and normal responder groups. Presence of cytoplasmic morphological abnormality was found to significantly correlate with the fertilization rate (P = 0.019) in poor responders. Conclusion: Our data show that oocyte cytoplasmic abnormalities significantly reduce fertilization achievement in poor responders.